Increasing pressures are resulting in NHS Trusts facing the choice of maintaining a focus on performance or prioritising the quality of patient care.

A survey of finance leads from clinical commissioning groups and trust finance directors by the King’s Fund’s reveals the financial pressures that trusts are facing. The NHS will struggle to meet its target of delivering £20 billion in productivity improvements by 2015. Only 10 per cent of NHS finance directors surveyed rated the chances of meeting the target as better than 50/50. The majority, 56 per cent, identified a high or very high risk that the target will not be met, while a third, 34 per cent, rated the likelihood of success as 50/50.

The survey highlights the growing pressures on NHS providers. Only a third of trusts surveyed expect to meet their cost improvement targets for 2013/14 – a sharp fall on the same quarter last year when nearly three-quarters were confident of meeting their targets. Commissioners are more optimistic, with 72 per cent of CCG finance leads expecting to meet their organisation’s targets.

Analysis of NHS performance data for the first quarter of 2013/14 shows most indicators are broadly stable, although A&E waiting times remain comparatively high. Over the quarter, 241,000 patients (4.3 per cent) spent four hours or more in A&E; although this is back within target range, it is the highest level for this quarter since 2004. With 61 hospitals breaching the government’s target, this reinforces the challenge the NHS faces in managing pressures in A&E over the coming winter, despite the new funding announced last week by the Secretary of State.

Professor John Appleby, Chief Economist at The King’s Fund said: ‘The findings from our survey of finance directors have become significantly more pessimistic over the past 12 months, reflecting the growing pressures on the NHS. Now just over half way through the so-called Nicholson Challenge, it is clear the NHS will struggle to meet its £20 billion productivity target, with potentially serious consequences for patient care. The reality for many hospitals is that they face an uncomfortable choice between whether to prioritise the quality of services for patients or allow performance in some areas to slip in order to balance the books.’